Case Report: Recurrent Acute Macular Neuroretinopathy—Monitoring Recovery with Multimodal Imaging

Abstract

SIGNIFICANCE Acute macular neuroretinopathy (AMN) is a rare, nonprogressive condition affecting the outer retina that can be diagnosed clinically using widely available multimodal imaging techniques. This case report presents an exceedingly rare same-eye recurrence of AMN and describes the characteristic imaging findings of this unique, not fully understood clinical entity. PURPOSE The following report provides a detailed account of recurrent AMN from 4 hours of symptom onset to 4 months with repeat multimodal imaging captured at different visits. This report also devotes some discussion to the current understanding of its pathophysiology, associations, management, and imaging characteristics. CASE REPORT A 32-year-old woman with unilateral recurrent AMN was monitored frequently with various multimodal imaging from 4 hours after onset of new scotoma to 4 months. The primary finding in the acute stage was a hyperreflective lesion of the outer nuclear and outer plexiform layers followed by disruption of underlying external limiting membrane, ellipsoid zone, and photoreceptors. This resolved into stable outer nuclear layer thinning and subtle disruption of the deeper layers after 1 week. Fundus photography revealed a red-brown petaloid lesion adjacent to the fovea, and optical coherence tomography angiography revealed subtle decreased perfusion of the choriocapillaris layer throughout follow-up. CONCLUSIONS Acute macular neuroretinopathy is a rare nonprogressive condition of the outer retina most often affecting otherwise healthy young female individuals and is most associated with recent flu-like illness and oral contraceptives. The underlying mechanism of AMN remains unknown, but modern imaging techniques have elucidated the disease locus to be choroidal and/or deep capillary plexus. It is important for eye care providers to recognize AMN as a clinical entity distinct from other retinal conditions that require different management.